SYNOPSIS OF VITAL RETURNS AND COMMENTS

ON SPECIAL DISEASES.

The records for the statistical year ending June 30th, 1884, as shown by the tables accompanying this report, give an aggregate of 8,968 marriages, 25,263 births, and 21,716 deaths. For the previous year, from July 1st, 1882, to July 1st, 1883, the record showed 9,166 marriages, 24,430 births, and 23,310 deaths. From July 1st, 1881, to July 1st, 1882, the record was 8,837 marriages, 23,108 births, and 25,959 deaths. These represent years in which the returns have been most complete, and are believed to show a reliable decrease in the death-rate of the State.

For these years the total deaths under five years of age were as

follows:

The following is the aggregate of deaths from zymotic diseases for the last three years in the State, each year being stated separately:

This gives 38.42, or over one-third of the deaths, as under five years of age, and 26.80, or over one-fourth, from this class of diseases. There is some difference of judgment as to one or two of the diseases to be classed as zymotic. The term means ferment, and was first applied to a class of diseases which were believed to depend upon some form of septic ferment developed under special circumstances. In

these, animal or vegetable decay or putrefaction was believed to give rise to special classes of symptoms, although the accurate chemical conditions which determined whether the disease should be one or the other was not known.

Since some form of vegetative life has come to be recognized as an essential factor in most if not all of these diseases, the former term is not so descriptive. They have been since associated under the names of communicable diseases, or preventable diseases, or filth diseases.

In the present state of our knowledge, it is recognized that the fevers spoken of as remittent or intermittent, typhus, typhoid, and relapsing fever and small-pox, scarlet fever, measles, whooping-cough, croup and diphtheria, erysipelas and diarrhea, as found among our infantile population, are dependent upon local conditions, or upon the conveyance of a contagion. Cholera and yellow fever belong to the same category. Consumption is recognized as largely owing to the local conditions of surroundings or to the diatheses of individuals, and is claimed by some to be communicable. However this may be, it is no doubt to a great degree a preventable disease. Many cases of brain and nervous disease, also, might well be classed as preventable. In the statistical tables as printed we give the causes in the more prominent or specified diseases. Also, for the purpose of showing the proportion of the diseases largely preventable, we associate together the first eight diseases named in the table, and add to it erysipelas, which has come to be regarded as a disease dependent on a specific contagion. In the above enumeration, and in our comparative percentage of socalled zymotic diseases as given in the table, all these are included. Also, typhus fever, which is very rare, but which, when occurring, is distinguished by a dot in the typhoid column of the office record. With the caution that all figures for a single year are approximate indications as to the healthfulness of persons in localities, to be corrected by comparisons with larger numbers over a larger number of years, and by incidental facts which modify their significance, we proceed to note in general some of the more prominent indications and facts as to the prevalence of various diseases. The first notable fact is a variation depending largely upon density of population. This is not only noticeable when we study a county like Hunterdon, with a death-rate of 11.12 per thousand, and compare it with Jersey City and Paterson at 25.15 and 28.33 respectively. Even with this we are to remember that Hunterdon county has a city so large as Lambertville,

which increases its death-rate over that of a county population. Also, that here and there a close street in a small village is also a factor in disease. It would be expected that the crowding of persons and of human habitations would increase the ratio of disease, but such is found to be the case to even a greater degree than general facts and principles would lead us to infer. For, with the direct effect there come, also, indirect or collateral evils, which affect the soil, both as to its drainage and its pollution, which affect both air and water-supply, and which lead to the collection of filth in many ways. Yet where this is realized and compensations are made, it is astonishing how possible it is to overcome the disadvantages, and, in fact, turn them into real advantages. Indeed, this has been so efficiently done in some of the larger English cities as to show that collections of population can be run economically for health, just as the division and classification of labor in large factories or industries often makes the loss far less than it would in a more restricted occupation. Speaking, for instance, of the lowered death-rate of London, Mr. R. Rawlinson, C.E., says: "Since 1848 cesspools have been abolished by tens of thousands, so that London at this day stands sewered, drained, and freed from most of its cesspools, and is in this respect the most fully water-closeted and cleanest great city in the world." Where it becomes esseential to classify work and to put it under expert administration, it is often far better done than if every one is left to do that which is right or wrong in his own sight.

But it must be fully and thoroughly realized that a house is an artificial thing, and that rows of houses filled with people are still more so, and that when we come to herd all classes of people in villages, towns and cities, we must recognize that we are placing them in unnatural conditions. Both nature and art must be so utilized and adjusted as to be compensatory, and then associated life becomes healthy as well as convenient. In accord with the general statement, we find that Bergen, Burlington, Cape May, Hunterdon, Morris, Somerset, Sussex and Warren counties have each a death-rate below fifteen deaths to every thousand inhabitants. These eight counties give an excellent showing for the year, although it should also be compared with that of the previous five years.

It has been claimed that the general death-rate of rural counties ought not to be higher than ten for the thousand in New Jersey. For counties with many towns and few cities of over five thousand popu

lation, seventeen deaths to the thousand has been stated as an average rate. The counties of Cumberland, Gloucester, Monmouth, Ocean ard Salem, although quite rural in their population, come in between fifteen and seventeen death-rate for the thousand. Between seventeen and twenty-one we have Atlantic, Camden, Mercer, Middlesex and Union counties. Atlantic county would not fall in this division but for the large and sudden influx of summer population, and even with this has a larger proportionate number of deaths, because of the invalidity of many that are brought there. The other counties show the quick effect of city populations, especially those of the labor classes. There are left the counties of Essex, Hudson and Passaic, with a death-rate of 22.17, 24.95 and 24.96, respectively. The death-rate of Hudson as a county is even higher than its death-rate as to its cities, because, in addition to great local disadvantages, these townships have thrust upon them many of the evils of the cities. They are made too much the dumping-places for all that is intolerable in the cities. In the case of North Bergen township, it should be included in the city death-rate, since it contains the almshouse, the penitentiary and the asylum of the county, and because of this has the highest township death-rate in the State. With the addition of cemeteries, odor factories, etc., it is not surprising that the whole county has so high a death-rate.

As we come to note the cities, these, too, differ among themselves as to death-rate, by reason of locality, of density and character of population, of trades and occupations, etc.

The lowest death-rates are those of Salem, 15.43; Plainfield, 16.25, and Rahway, 17.19. A reference to the birth-rates, however, will show that this low death-rate does not fully indicate the relative health of these places since they are defective in birth-rate and child population, and, so, have less of the material most susceptible to disease. Business depression, too, sometimes leads the younger and family classes to move away, while the middle-aged and the old, who have become fixtures, have to stay.

Next to these cities we find Phillipsburg, 18.10; Millville, 18.54; Bridgeton, 18.69; Burlington, 18.93. All these and other localities should be compared with the death-rates of the combined five previous years, as often, for a single year, the variations are from incidental

causes.

Next are Bordentown, 19.68; Morristown, 20.77; Elizabeth, 20.93.

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Between a death-rate of 21 and 24, other cities take their places in the following order: Trenton, Gloucester City, Orange, Harrison, Hoboken, Bayonne, Camden, Chambersburg, New Brunswick, Passaic and Town of Union.

Above a death-rate of 24 to the 1,000, we find in their order, Newark, Jersey City and Paterson.

We do not include Atlantic City for reasons already given, as, no doubt, but for its summer population its rate would be less by nearly one-half.

In most of our cities it is not yet time for sanitary measures to make themselves felt largely as to the general death-rate, although it should be manifest on some of the more preventable diseases. The cities of Camden, Newark and those of Hudson county, by reason either of Boards of defective powers, or their want of funds, have had no adequate sanitary care. Paterson has only within a year been placed on a basis of sanitary administration. Besides, with the increase of population, as to which our approaching census will inform us, the statement of death-rate for this year is, probably, calculated upon too small a population. It did not seem best to us to apply a table as to approximate population until we had the facts of the semidecennial census. But, with the facts we have, there is much material for study. Also, it is only by getting the more general facts, and by their study, that we get that analysis which has always been found in the past a valuable guide in studying the health problems of society.

DEATHS UNDER FIVE YEARS IN COMPARISON WITH TOTAL DEATHS.

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Of equal, if not greater, significance will be found a study of the comparative deaths under five years of age. These are very properly accepted as showing much as to the vigor of population and influences unfriendly to health. It is to be borne in mind that this column is not the death-rate for each 1,000, but a comparison between the total deaths and the deaths under five years of age. Such an exhibit of the percentage, which these deaths bear to the whole, show how many die at this early age and, also, how many more of such die in close cities and certain populations. It is a very unnatural thing for a child to die. It is only because we come to regard what is common as natural that such a mortality among the young does not at once, in the interests of social life and prosperity, compel a rigid